Background

Robot-assisted laparoscopic (RAL) implantation of brachytherapy catheters (BTCs) can be a minimally invasive alternative to open retropubic implantation. Descriptions of the surgical technique and outcomes are sparse.

Objective

To describe our technique and perioperative outcomes for RAL BTC implantation in urothelial carcinoma (UC) and urachal carcinoma (UraC).

Design, setting and participants

Between June 2011 and May 2016, 26 patients with cN0M0 solitary T1G3 or T2G1–3 UC of ≤5 cm or cN0M0 UraC were scheduled for external beam radiotherapy (20 × 2 Gy), RAL BTC implantation, and pulsed-dose (29 × 1.04 Gy) or high-dose rate brachytherapy (10 × 2.50 Gy). Median follow-up was 12 mo (interquartile range 4–20).

Surgical procedure

RAL BTC implantation with or without pelvic lymph node dissection and/or partial cystectomy.

Measurements and statistical analysis

Perioperative data, complications, disease-free-survival (DFS), local recurrence-free survival (LRFS), and cystectomy-free survival (CFS) were evaluated as well as the feasibility of the technique.

Results and limitations

BTC implantation was successful in 92% of the patients. Median hospitalisation was 5 d (interquartile range 4–7) and blood loss <50 ml in all cases. DFS was 74% at 1 yr and 63% at 2 yr. LRFS was 80% at 1 and 2 yr, and CFS was 87% at 1 and 2 yr. Early (≤30 d) high-grade complications (Clavien-Dindo ≥3) occurred in 8% of the patients. The study is limited by the small sample size and short follow-up time.

Conclusions

RAL BTC implantation is technically feasible and could serve as safe, minimally invasive alternative to open surgery in selected patients. The results of this study should be confirmed in larger studies.

Patient summary

Brachytherapy catheter (BTC) implantation is traditionally carried out via open retropubic surgery. We describe robot-assisted laparoscopic BTC implantation as a minimally invasive alternative. Perioperative outcomes are described and confirm the safety and feasibility of this procedure.

中文翻译：

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膀胱癌机器人辅助腹腔镜植入近距离放射治疗导管

背景

机器人辅助的近距离放射治疗导管（BTC）的腹腔镜（RAL）植入可以是耻骨后耻骨植入的微创替代方法。手术技术和结果的描述很少。

客观的

为了描述我们的技术和尿道上皮癌（UC）和尿道上皮癌（UraC）中的RAL BTC植入的围手术期结局。

设计，设置和参与者

在2011年6月至2016年5月之间，计划对26例cN0M0单独的T1G3或T2G1–3 UC≤5 cm或cN0M0 UraC的患者进行外照射（20×2 Gy），RAL BTC植入和脉冲剂量（29×1.04） Gy）或高剂量近距离放射疗法（10×2.50 Gy）。中位随访时间为12 mo（四分位间距4-20）。

手术程序

带或不带盆腔淋巴结清扫术和/或部分膀胱切除术的RAL BTC植入。

测量和统计分析

评估围手术期数据，并发症，无疾病生存期（DFS），无局部复发生存期（LRFS）和无膀胱切除术生存期（CFS）以及该技术的可行性。

结果与局限性

BTC植入在92％的患者中是成功的。在所有情况下，中位住院时间为5 d（四分位间距为4-7），失血量少于50 ml。DFS在1年时为74％，在2年时为63％。在1年和2年时，LRFS为80％，而在1年和2年时，CFS为87％。8％的患者发生了早期（≤30 d）严重并发症（Clavien-Dindo≥3）。该研究受到样本量小和随访时间短的限制。

结论

RAL BTC植入在技术上是可行的，并且可以作为选定患者中开放手术的安全，微创替代方案。这项研究的结果应在更大的研究中得到证实。

病人总结

传统上，近距离放射导管（BTC）植入是通过耻骨后开放手术进行的。我们将机器人辅助的腹腔镜BTC植入描述为一种微创替代方案。描述围手术期结局，并确认该手术的安全性和可行性。